Bipolar disorder – We don’t all have the same exact “flavor” of the illness

bipolar disorder image

One of my blog followers asked if I could describe the differences between Bipolar type 1 and Bipolar type 2 disorders, the most common disorders on what is a bipolar spectrum of disorders. I thought about how I would approach such an article considering the extreme number of articles on this subject online and in books. With only a few exceptions, most of these articles look about the same. They basically say the following:

Bipolar type 1 must include at least one full blown manic episode not attributable to certain drug use or other illness, diagnosed by a healthcare professional qualified to diagnose mental illnesses. It may also be preceded or followed by hypomanic (a milder form of mania) or major depressive episode(s). The latter two are usually always experienced at some point, but are not mandatory for the Bipolar type 1 diagnosis.

Bipolar type 2 must include at least one current or past hypomanic episode (milder form of mania) not attributable to certain drug use or other illness, AND a current or past major depressive episode. People with Bipolar type 2, must have experienced both types of episodes for diagnosis of the disorder (unlike people with Bipolar type 1), and have received the diagnosis from a healthcare professional qualified to diagnose mental illnesses.

For the diagnosis of bipolar episodes, there are minimum episode lengths, minimum number of symptoms required and total criteria that need to be met. These vary by episode type. Symptoms for full blown mania and hypomania are mostly exactly the same. So you may ask “If the symptoms are pretty much the same for full blown mania and hypomania, what makes them one vs. the other?” The answer is a matter of degree of severity of the symptoms. A doctor qualified to diagnose mania vs. hypomania will make that determination. Factors such as whether the mania was severe enough for hospitalization or major life disruption may also play a part.

To see an informal list of symptoms for mania, hypomania and major depression see the National Institute of Mental Health’s bipolar episode symptom list.

I mentioned “flavors” of bipolar disorder in my blog post title. I did so because not every person with Bipolar type 1 experiences the illness exactly the same, and ditto for people with Bipolar type 2. Some people afflicted will not experience all of the same symptoms as others, or sometimes individual episodes include different sets of symptoms. Some people experience episodes more rapidly than others (“rapid cycling”), on the whole, or at times. Some people are prone to what is called “mixed features”, where an episode combines manic or hypomanic symptoms with major depressive symptoms at the same time. In the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), there are several specifiers (like “with mixed features” or “with rapid cycling”) that provide more details on possible extra characteristics of episodes. A couple of others that are common include “with anxious distress” or “with mood-congruent (or mood-incongruent) psychotic features”. These characteristics are possible in either type of bipolar disorder, with the psychotic features generally only during some depressions in Bipolar type 2.  Pure mania or hypomania may not always be elated. Sometimes they can be quite irritable (even to the point of aggression), or a combination of the two.

Some people with either bipolar type may be hospitalized several times throughout their lives, others never. The impact on a given person’s life may vary greatly, too. Though some people may think that Bipolar type 2 is a milder version of the illness, that may not be the case. Some people with Bipolar type 2 experience depressions far more severe and disabling than the full blown manias or depressions of people with Bipolar type 1. Again, other times not. Also, according to a 2002 study by Lewis L. Judd et al. published in the Archives of General Psychiatry, on average, people with Bipolar type 2 experience the whopping ratio of time in depression to hypomania as 40:1, while people with Bipolar type 1 on average experience time in depression to full blown mania as 3:1

People with both disorders may sometimes only experience low grade depressions that affect their lives in minor ways. Others may experience depressions so severe that they cannot perform their job, move from their bed, suffer psychosis, be of harm to themselves or possibly commit suicide, and/or require hospitalization. One can have mild, moderate and/or severe depressions at some point(s) during their life. How many of what severity varies. Often people slowly experience all levels as they fall into or pull out of this state.

Like the depressions I mentioned above, hypomania can be mild to the point where symptoms are exhibited, but daily life can easily continue. However, to qualify for a hypomanic episode, a person’s behavior must show an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic, and be observable by others. Moderate hypomania would be particularly uncharacteristic of the person, but still not severe enough to cause significant impairment in social or occupational functioning, or to necessitate hospitalization, unless severe enough mixed features are present.

All pure full blown manic episodes are severe enough to cause marked impaired social or occupational functioning, and may necessitate hospitalization to prevent harm to self or others. Some full blown manias may also include psychotic features. Full blown manias can affect a person’s life in terribly negative ways. Examples may include job loss, marriage ruin (perhaps from adultery), financial ruin, arrest, harm to self or others, and commitment into a hospital. Or even if a full blown manic person avoids such extreme tragedies, generally some price is usually paid, even if it equated to buying 10 snake bite kits you didn’t need, embarrassing yourself in public, shaving your head, or getting a tattoo you’d normally never get.

Both types of bipolar disorder are serious diagnosable mental illnesses. Bipolar disorder is not a negative personality trait. Both are considered to be mood disorders. There is still a lot of stigma attached to bipolar disorder (both types) and other mental illnesses, including diagnosable personality disorders. Stigma is unfair and generally based on lack of knowledge. When a person flippantly refers to a workmate, friend or acquaintance as “bipolar” without actual knowledge of their having a diagnosed mental illness, it lessens the seriousness of the struggle faced by those who truly experience significant mood elevation and depression. At the same time, using unkind labels like “nut job”, “loony”, and the like, are cruel. One would usually never treat someone with heart disease or breast cancer in such a manner.

If anyone has any questions or comments about this post, please feel free to share them.

Resources:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013

http://bipolar.answers.com/treatment/new-and-promising-methods-for-treating-bipolar-depression

https://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml#pub5

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34 thoughts on “Bipolar disorder – We don’t all have the same exact “flavor” of the illness

  1. flhockeymomfit September 6, 2017 / 3:11 am

    Very informative post and truly on point. Bipolar is a serious, but treatable illness and should be treated as such. Thank you.

    Liked by 1 person

  2. Melissa A. September 6, 2017 / 3:59 am

    Thanks for posting this, it satisfied my curiosity. I still don’t understand the need to separate the two types since they sound so similar. However, I think researchers and doctors need two types in order to properly diagnose and treat patients; I don’t think it matters as much to the patient’s themselves, as they only know how they are feeling. As long as their treatment plan is working, and they can function, then they probably don’t think about whether they have Bipolar Type 1 or Type 2.

    I’m not meaning to offend anyone or belittle a serious illness! I simply don’t see many differences.

    Liked by 1 person

    • updownflight September 6, 2017 / 4:37 am

      Hi Melissa. To some with bipolar 1, full blown mania is a definite difference, as is the increased amount of time spent depressed for those with bipolar 2, but you make a good point. Some people really don’t care about the differences that much.

      I will say that over the past 12 years being medicated and learning about others’ medications, there are some important differences. Though not always the case, usually people with bipolar type 1 will have medication cocktails heavier on the antimanics. I can say for myself that I could not take the medication cocktails of most people with bipolar type 2, although some medication(s) will usually be similar or the same.

      The experiences do vary. Very few people with bipolar type 2 that I know would be dragged by multiple men into isolation rooms, held down, given injections, and locked in the room for hours or possibly days. Or even arrested by the police. That wouldn’t happen with hypomania, and I doubt with most depressions unless they were psychotic, which is less common than psychosis in mania.

      Liked by 1 person

      • Melissa A. September 6, 2017 / 2:18 pm

        “Very few people with bipolar type 2 that I know would be dragged by multiple men into isolation rooms, held down, given injections, and locked in the room for hours or possibly days. Or even arrested by the police.”

        Wow, if that’s the case, then there is definitely a big difference! This one statement helped me to understand better than the entire post.

        Thanks for responding to my comment. Have a good day 🙂

        Liked by 1 person

      • updownflight September 6, 2017 / 3:34 pm

        Perhaps I should revisit my post and add a few extra details based on your comment and one from another blogger. I appreciate such feedback. It will help me to improve my post.

        Like

      • Melissa A. September 6, 2017 / 3:40 pm

        Awe, you don’t need to go to any extra trouble! I’m don’t have Bipolar Disorder and I’m just curious because my daughter might be. But she’ll never be diagnosed because the last time she tried to get help, she ended up in the hospital, near death, because the psychiatrist (who was fresh out of school) prescribed her too much lithium.

        So, on my part, it’s more of a learning thing than anything else. 🙂

        Liked by 1 person

      • updownflight September 6, 2017 / 3:46 pm

        I’m so sorry your daughter suffered Lithium toxicity. I hope she doesn’t have any damage to her kidneys or the like. I took Lithium for years and it did damage my kidneys a little bit, but not from toxicity. I was just vulnerable to the damage, I guess.

        Liked by 1 person

      • Melissa A. September 6, 2017 / 3:49 pm

        Yes, she did have some damage to her kidneys. That’s why she refuses to seek help now. Which I can understand, to an extent.

        Liked by 1 person

      • updownflight September 6, 2017 / 3:50 pm

        I see, but I wish a doctor would let her know that most bipolar medications go through the liver and not the kidneys. I’ve rarely ever heard of anyone having trouble with their liver because of bipolar meds.

        Like

      • Melissa A. September 6, 2017 / 4:12 pm

        Maybe…we don’t talk much. Thanks anyways 🙂

        Liked by 1 person

  3. Iggy September 6, 2017 / 11:07 am

    excellent post. It should be noted that there are other forms of bipolar also; Bipolar NOS, Cylcothymia, and Rapid Cycling. But I understand that the initial post was the difference between I and II.

    Liked by 1 person

    • updownflight September 6, 2017 / 1:12 pm

      Hi and thanks Iggy. I did mention rapid cycling, but you’re right, I should at least mention that there are other types on the spectrum that are not as commonly discussed, like Cyclothymia, BP 3, etc. I’ll add a note to that effect after my morning appt.

      Liked by 1 person

      • Iggy September 6, 2017 / 7:24 pm

        Sorry, I must have missed the rapid cycling. And I wasn’t trying to tell you how to advocate. I feel kinda bad for even mentioning anything. I hope you are not offended.

        Liked by 1 person

      • updownflight September 6, 2017 / 7:41 pm

        No, Iggy! I appreciated your feedback. I made some changes based on yours and another blogger’s comments because I thought it was helpful feedback.

        So you know, I followed the examples of the DSM-5 when writing about mixed features and rapid cycling. The DSM-5 regards them as specifiers now and not types of bipolar disorder.

        I thought for the sake of simplicity I wouldn’t mention Cyclothymia, Bipolar type 3, or Bipolar NOS by name, but I did hint that there were other types of related disorders on the bipolar spectrum of disorders. Surely some people are not familiar with the term “bipolar spectrum”, but I think most will sort of get the drift. I hope.

        Liked by 1 person

      • Iggy September 6, 2017 / 7:46 pm

        Well I’m glad you found it helpful. Sometimes I come across wrong, and I didn’t want that to be the case. 🙂 I thought the piece was really great, I’ll have to re-read it tonight.

        Liked by 1 person

      • Iggy September 6, 2017 / 7:48 pm

        p.s. thanks for the info on the specifiers. It is so hard to keep up with the DSM. It is like trying to keep up with a fickle teenage girl; everchanging. 🙂

        Liked by 1 person

      • updownflight September 6, 2017 / 8:31 pm

        Thanks, Iggy! Yes indeed the DSM does change a lot. I wonder what the sixth edition will be like?

        Liked by 1 person

  4. Cogitator September 6, 2017 / 3:50 pm

    Thanks, clear and well researched. And comforting to know we are all difference… I keep thinking that because some of my symptoms don’t seem as bad, I have been mis-diagnosed or making the whole thing up.

    Liked by 1 person

    • updownflight September 6, 2017 / 3:53 pm

      Hi Cogitator. I think you’re not alone, at all. People who have suffered even the worst episodes sometimes question that they have the illness when they get a period of stability. It is so common. But do discuss the issue with your psychiatrist.

      Like

  5. cognitiveagonist September 13, 2017 / 12:57 am

    Another thing to think about is that the treatment for bipolar I and II is often quite similar. A non-SSRI antidepressant, a mood stabilizer, maybe an antipsychotic and an anxiolytic. So that’s a view of things where the exact diagnosis doesn’t really matter. Sometimes I think we could just say “mood disorder” and leave it at that.

    Liked by 1 person

    • updownflight September 13, 2017 / 6:40 am

      That’s true, but most of the people with bipolar type 1 that I know, including me, can’t take any kind of antidepressant at all. They always made me manic or manic with mixed features. For depression, I have to use a moodstabilizer and antipsychotic known to be helpful for depression (Lamictal and Seroquel XR). The rest of my mix is antimanic.

      Like

    • updownflight September 23, 2017 / 1:18 pm

      Hi Life of Me. People with hypomania have mild manic symptoms that are noticeable, but not so much to warrant hospitalization, cause major fear, or possible major life disruptions (unless it is part of some abusive nature when stable, as well).

      An elated hypomanic might get angry when they normally wouldn’t and sleep in the guest room. A full blown manic might disappear for days or months.

      A hypomanic might get much more involved in goal oriented projects like suddenly deciding to paint the walls in the house, while a manic person might unexpectedly buy a new house.

      A hypomanic person will not have psychosis unless they also have very severe depression that causes it or some other illness, too, like schizophrenia. Manic people can become psychotic from mania alone.

      Like

      • The Life of Me September 23, 2017 / 1:27 pm

        Ah, I see. I recently realized my friend is bipolar. She never told me before, but she had an episode the other day in which she was 302’ed and it became obvious. In retrospect, its like she was progressively getting worse, and then it blew up one day (when we called the cops). I did not realize there were multiple types of bipolar.

        Liked by 1 person

      • updownflight September 23, 2017 / 1:54 pm

        I’m sorry your friend is ill, The Life of Me. I hope they find a good treatment for her.

        Like

  6. marandarussell September 24, 2017 / 1:47 am

    Good post. My psychiatrist diagnosed me with Bipolar type 2, but even he said that I didn’t exactly perfectly fit the category, in fact, he said I didn’t exactly fit in any of the known mood disorder categories, but I guess I fit close enough to be diagnosed. I try not to worry too much about the labels. Just be me and try to be healthy.

    Liked by 1 person

    • updownflight September 24, 2017 / 6:11 am

      Hi marandarussell. The bipolar spectrum is a very varied group of possibilities.

      Like

  7. arsenios November 1, 2017 / 2:43 pm

    .
    I sentiment for the rice beer of simple mindedness I wouldn’t honorable mention Cyclothymia, Bipolar case 3, or Bipolar NOS by epithet, but I did breath that there were other cases of related disorders on the bipolar spectrum of disorders.

    Liked by 1 person

    • updownflight November 1, 2017 / 5:26 pm

      Hi ardenios. Yes, you are correct about other less commonly diagnosed disorders on the bipolar spectrum. Though I did imply there were others, I didn’t name them so as to avoid confusion and a necessity to describe all in detail. I decided to just focus on types 1 and 2. Most people unfamiliar with these disorders don’t even know there is more than one type, I believe. Do you or someone you know have Cyclothymia or another type?

      Like

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